Child's Nervous System

, Volume 32, Issue 11, pp 2211–2217 | Cite as

Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study

  • I. Cabrera-Martos
  • M. C. Valenza
  • G. Valenza-Demet
  • A. Benítez-Feliponi
  • C. Robles-Vizcaíno
  • A. Ruiz-Extremera
Original Paper



Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly.


This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4–5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge.


Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment.


Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.


Nonsynostotic plagiocephaly Musculoskeletal manipulations Paediatrics Motor development 


Compliance with ethical standards

Conflict of interest

One of the authors (ICM) received a grant from the Ministry of Education, Culture, and Sport of Spain to support this research (FPU grant AP2010-3603).


  1. 1.
    Amiel C, Soyez E (2008) Place de l’ostéopathie dans la correction des déformations crâniennes du nouveau-né et du jeune enfant. Cranial osteopathy as a complementary treatment of postural plagiocephaly. Arch Pédiatr 15:S25–S31Google Scholar
  2. 2.
    Argenta L, David L, Thompson J (2004) Clinical classification of positional plagiocephaly. J Craniofac Surg 15(3):368–372CrossRefPubMedGoogle Scholar
  3. 3.
    Bialocerkowski AE, Vladusic SL, Wei Ng C (2008) Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol 50(8):577–586CrossRefPubMedGoogle Scholar
  4. 4.
    Boere-Boonekamp MM, van der Linden-Kuiper AT (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343CrossRefPubMedGoogle Scholar
  5. 5.
    Cabrera-Martos I, Valenza MC, Benítez-Feliponi A, Robles-Vizcaíno C, Ruiz-Extremera A, Valenza-Demet G (2013) Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv Syst 29(10):1893–1898CrossRefPubMedGoogle Scholar
  6. 6.
    Carreiro JE (2003) An osteopathic approach to children. Churchill Livingstone, EdinburghGoogle Scholar
  7. 7.
    Couture DE, Crantford JC, Somasundaram A, Sanger C, Argenta AE, David LR (2013) Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases. Neurosurg Focus 35(4):E4CrossRefPubMedGoogle Scholar
  8. 8.
    Graham JM, Gomez M, Halberg A, et al. (2005) Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 146(2):258–262CrossRefPubMedGoogle Scholar
  9. 9.
    Hutchison BL, Stewart A, De Chalain T, Mitchell E (2012) Serial developmental assessments in infants with deformational plagiocephaly. J Paediatr Child Health 48:274–278CrossRefPubMedGoogle Scholar
  10. 10.
    Kluba S, Kraut W, Reinert S, Krimmel M (2011) What is the optimal time to start helmet therapy in positional plagiocephaly? Plast Reconstr Surg 128(2):492–498CrossRefPubMedGoogle Scholar
  11. 11.
    Lalauze-Pol R (2003) Le crane du nouveau-né. Sauramps médical, MontpellierGoogle Scholar
  12. 12.
    Lessard S, Gagnon I, Trottier N (2011) Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract 17(4):193–198CrossRefPubMedGoogle Scholar
  13. 13.
    Losee J, Corde A (2005) Deformational plagiocephaly: diagnosis, prevention, and treatment. Clin Plast Surg 32(1):53–64CrossRefPubMedGoogle Scholar
  14. 14.
    Nelly KM, Littlefield TR, Pomatto JK, Ripley CE, Velas SP, Joganic EF (1999) Importance of early recognition and treatment of deformational plagiocephaly with orthotic cranioplasty. Cleft Palate Craniofac J 36:127–130CrossRefGoogle Scholar
  15. 15.
    Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, Levine N (2001) Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 108(6):1492–1498CrossRefPubMedGoogle Scholar
  16. 16.
    Philippi H, Faldum A, Schleupen A, et al. (2006) Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol 48:5–9CrossRefPubMedGoogle Scholar
  17. 17.
    Piper MC, Darrah J, Maguire TO, Redfern L (1994) Motor assessment of the developing infant. Saunders, PhiladelphiaGoogle Scholar
  18. 18.
    Piper MC, Darrah J (1995) Response to Dr. Coster’s critique of the Alberta Infant Motor Scale (AIMS). Phys Occup Ther Pediatr 15:65–69CrossRefGoogle Scholar
  19. 19.
    Pollack IF, Losken HW, Fasick P (1997) Diagnosis and management of posterior plagiocephaly. Pediatrics 99(2):180–185CrossRefPubMedGoogle Scholar
  20. 20.
    Pople IK, Sanford RA, Muhlbauer MS (1996) Clinical presentation and management of 100 infants with occipital plagiocephaly. Pediatr Neurosurg 25(1):1–6CrossRefPubMedGoogle Scholar
  21. 21.
    Sergueef N, Nelson KE, Glonek T (2006) Palpatory diagnosis of plagiocephaly. Complement Ther Clin Pract 12:101–110CrossRefPubMedGoogle Scholar
  22. 22.
    Sutherland WG (1990) Teaching in the science of osteopathy. Sutherlaned Cranial Teaching, Texas FoundationGoogle Scholar
  23. 23.
    Van Vlimmeren L, Van der Graaf Y, Boere-Boonekamp M, L’Hoir M, Helders P, Engelbert R (2008) Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference. A randomized controlled trial. Arch Pediatr Adolesc Med 162(8):712–718CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • I. Cabrera-Martos
    • 1
  • M. C. Valenza
    • 1
    • 2
  • G. Valenza-Demet
    • 1
  • A. Benítez-Feliponi
    • 3
  • C. Robles-Vizcaíno
    • 3
  • A. Ruiz-Extremera
    • 4
  1. 1.Department of Physical Therapy, Faculty of Health SciencesUniversity of GranadaGranadaSpain
  2. 2.Department of Physiotherapy, Faculty of Health SciencesUniversity of GranadaGranadaSpain
  3. 3.Early Care and Monitoring Unit, Pediatrics ServiceSan Cecilio Clinical HospitalGranadaSpain
  4. 4.Department of Pediatrics, Faculty of MedicineUniversity of GranadaGranadaSpain

Personalised recommendations